Coding and Coverage

CPT® codes are likely considered the universal language between your physician and insurance company for describing services provided. Your provider will utilize two distinct CPT codes for reporting the UroLift® System treatment. CPT code 52441 is used by your physician to report to your insurance plan the UroLift System treatment including the initial implant; CPT code 52442 is used to report the delivery of each additional implant. The number of implants will vary due to the unique characteristics of the prostate, but clinical data supports an average of 4-6 implants per procedure.

Medicare across the country is routinely covering the UroLift System treatment and it continues to gain favorable commercial coverage. To learn more about the insurance company(s) important to you, check with the NeoTract, Inc. Reimbursement Team at (844) 516-5966 or by email at uroliftreimbursement@teleflex.com.

Prior Authorization

Medicare

The Medicare program does not require prior authorization for the UroLift System treatment.

Commercial Payers

Prior authorization is recommended for all UroLift System treatments. Your physician’s office will work with you and your insurance plan to understand their prior authorization requirements before initiating treatment.

Prior authorization may be denied for the UroLift System treatment because some insurance plans do not yet have enough information about the technology to make a favorable decision. If this happens, you and your physician have the right to appeal the denied prior authorization. Consult with your physician’s office and/or your insurance company for their appeal process.

For general information about how or when to submit an appeal, please contact the NeoTract, Inc. Reimbursement Team toll free at (844) 516-5966 or by email at uroliftreimbursement@teleflex.com.

Denials & Appeals

Whether you receive a prior authorization denial, treatment denial or insufficient payment, you and your physician have the right to appeal. The appeal process ensures that critical patient treatment decisions are given appropriate consideration by your insurance company. When appealing, you and/or your physician’s office should refer to and follow the health plan’s defined appeal process.

Denials may be the result of your insurance plan not fully understanding the UroLift System treatment. It is not uncommon for new technologies to initially be labeled by insurance companies as experimental or investigational. An effective way to address non-coverage is through the physician and patient appeal process.

Disclaimer: NeoTract, Inc. has compiled this coding information from third party sources and is subject to change without notice. This information is presented for illustrative purposes only and does not constitute legal or reimbursement advice. It is always the provider’s responsibility to determine medical necessity and appropriate site of service, and submit appropriate codes, modifiers and charges for services rendered. Please contact your local payer/carrier and/or legal counsel for interpretation of coding and coverage.